[Reconocimiento del mesotelioma de pleura como enfermedad profesional en la Comunidad Valenciana de 2012 a 2018.] / Recognition of pleural mesothelioma as an occupational disease in the Valencian Community from 2012 to 2018.

OBJECTIVE: Pleural mesothelioma is a neoplasm almost exclusively attributed to occupational exposure to asbestos and is legally considered an occupational disease. Nevertheless, only a few cases achieve that official recognition. The objective of this work was to describe and analyse this issue, and to identify the major obstacles to its recognition. METHODS: A descriptive and retrospective epidemiological study of data was carried out, including figures and some characteristics, of all patients with pleural mesothelioma registered in the official health and labor registries of the Valencian Community from 2012 to 2018, using frequencies, proportions, and incidence rates. RESULTS: There were large differences between the two sets of data collected in the different registries, especially regarding the number of cases. During the seven years of data examined, 590 pleural mesotheliomas were diagnosed in the Valencian public health system. Of these, the number of cases that were related to occupational exposure was at least 437. Despite the legal duty of doctors to report such cases, only 31 were reported as suspected occupational disease (7.09%), of which only 13 were ultimately officially recognized as such. It was estimated that the annual economic overcost to the public system of unrecognised patients with this occupational disease by was 2,2270,520 euros. CONCLUSIONS: Only a small proportion of occupational mesotheliomas are officially recognized as such. This has important health care and economic repercussions for the individuals involved as well as for the public health system.

OBJETIVO: El mesotelioma de pleura es un cáncer atribuido casi en exclusiva a la exposición laboral al amianto y que tiene la consideración legal de enfermedad profesional, aunque pocos casos consiguen ese reconocimiento oficial. Describir y analizar este problema y los obstáculos para su reconocimiento fue el objetivo de este trabajo. METODOS: Se realizó un estudio epidemiológico descriptivo y retrospectivo de las cifras y algunas características de todos los pacientes de mesotelioma de pleura recogidos en los principales registros oficiales, sanitarios y laborales, de la Comunidad Valenciana, desde 2012 a 2018, utilizando frecuencias, fracciones y tasas de incidencia. RESULTADOS: Hubo grandes diferencias en el número de casos recogidos en los distintos registros. En los siete años estudiados, los mesoteliomas de pleura diagnosticados en el sistema sanitario público valenciano fueron 590. De ellos, aplicando la fracción atribuible al trabajo con amianto, al menos 437 fueron atribuibles al trabajo. Los facultativos comunicaron 31 casos como sospechas de enfermedad profesional, el 7,09% del total, y, finalmente, 13 casos se reconocieron oficialmente como enfermedad profesional. El coste económico estimado de su atención sanitaria para el sistema público valenciano fue de 2.270.520 euros. CONCLUSIONES: Una mínima parte de los mesoteliomas obtienen el reconocimiento de enfermedad profesional. Este hecho conlleva importantes repercusiones asistenciales y económicas para las personas afectadas y para el sistema sanitario público.

Reconocimiento del mesotelioma de pleura como enfermedad profesional en la Comunidad Valenciana de 2012 a 2018 / Recognition of pleural mesothelioma as an occupational disease in the Valencian Community from 2012 to 2018

Fundamentos: El mesotelioma de pleura es un cáncer atribuido casi en exclusiva a la exposición laboral al amianto y que tienela consideración legal de enfermedad profesional, aunque pocos casos consiguen ese reconocimiento oficial. Describir y analizar esteproblema y los obstáculos para su reconocimiento fue el objetivo de este trabajo. Métodos: Se realizó un estudio epidemiológico descriptivo y retrospectivo de las cifras y algunas características de todos los pa-cientes de mesotelioma de pleura recogidos en los principales registros oficiales, sanitarios y laborales, de la Comunidad Valenciana,desde 2012 a 2018, utilizando frecuencias, fracciones y tasas de incidencia. Resultados: Hubo grandes diferencias en el número de casos recogidos en los distintos registros. En los siete años estudiados,los mesoteliomas de pleura diagnosticados en el sistema sanitario público valenciano fueron 590. De ellos, aplicando la fracciónatribuible al trabajo con amianto, al menos 437 fueron atribuibles al trabajo. Los facultativos comunicaron 31 casos como sospechasde enfermedad profesional, el 7,09% del total, y, finalmente, 13 casos se reconocieron oficialmente como enfermedad profesional. Elcoste económico estimado de su atención sanitaria para el sistema público valenciano fue de 2.270.520 euros. Conclusiones: Una mínima parte de los mesoteliomas obtienen el reconocimiento de enfermedad profesional. Este hechoconlleva importantes repercusiones asistenciales y económicas para las personas afectadas y para el sistema sanitario público.(AU)

Background: Pleural mesothelioma is a neoplasm almost exclusively attributed to occupational exposure to asbestos and islegally considered an occupational disease. Nevertheless, only a few cases achieve that official recognition. The objective of this workwas to describe and analyse this issue, and to identify the major obstacles to its recognition. Methods: A descriptive and retrospective epidemiological study of data was carried out, including figures and some characteristics,of all patients with pleural mesothelioma registered in the official health and labor registries of the Valencian Community from 2012 to2018, using frequencies, proportions, and incidence rates.Results: There were large differences between the two sets of data collected in the different registries, especially regarding thenumber of cases. During the seven years of data examined, 590 pleural mesotheliomas were diagnosed in the Valencian public healthsystem. Of these, the number of cases that were related to occupational exposure was at least 437. Despite the legal duty of doctorsto report such cases, only 31 were reported as suspected occupational disease (7.09%), of which only 13 were ultimately officiallyrecognized as such. It was estimated that the annual economic overcost to the public system of unrecognised patients with thisoccupational disease by was 2,2270,520 euros. Conclusions: Only a small proportion of occupational mesotheliomas are officially recognized as such. This has importanthealth care and economic repercussions for the individuals involved as well as for the public health system.(AU)

Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015-2019).

BACKGROUND AND OBJECTIVE: Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs). OBJECTIVE: Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015-2019. METHOD: Descriptive population-based study. SETTING: 'València-Clínic-Malvarrosa' Health Department, Valencia, Spain. PERIOD: 2015-2019. SUBJECTS: Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. ANALYSES: frequencies and time trends, both overall and by specific type. RESULTS: Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: "≥75 years of age with inappropriate medication", which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics). CONCLUSIONS: IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs.

Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015–2019) / Prevalencia de prescripción inapropiada en pacientes crónicos complejos: tendencias temporales en un departamento de salud de Valencia, España (2015-2019)

Background and objective: Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs).Objective: Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015–2019.Method: Descriptive population-based study. Setting: ‘València-Clínic-Malvarrosa’ Health Department, Valencia, Spain. Period: 2015–2019. Subjects: Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. Analyses: frequencies and time trends, both overall and by specific type.Results: Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: “≥75 years of age with inappropriate medication”, which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics).Conclusions: IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs. (AU)

Antecedentes y objetivo: La prescripción inapropiada (PI) es una importante causa de problemas de salud en las personas mayores y pacientes crónicos complejos (PCC). Objetivo: Monitorizar la prevalencia de PI en personas mayores y PCC, en un departamento de salud. Tendencias temporales de la PI durante 2015-2019.Método: Estudio descriptivo de base poblacional. Lugar: Departamento de Salud «València-Clínic-Malvarrosa», Valencia, España. Periodo: 2015-2019. Sujetos: Conjunto completo de PCC en el Departamento, definidos mediante Clinical Risk Groups. Número de PCC (valor promedio anual en el periodo): 9.102 (75% ≥65 años de edad). La PI se cuantificó mediante un indicador que comprende 13 tipos concretos de prescripciones definidas como inapropiadas. Análisis: frecuencias y tendencia temporal, global y por tipos.Resultados: La prevalencia global de PI osciló entre 0,276 (2015) y 0,289 (2018) por paciente, sin tendencia temporal. El tipo concreto de PI más frecuente fue el 1: «≥75 años con medicación inapropiada», y fue estable en el periodo. Algunos de los tipos inapropiados de prescripción mostraron evolución temporal favorable, descendente; pero en otros no hubo cambios o fue desfavorable (como la prescripción conjunta de absorbentes y antiespasmódicos urinarios).Conclusiones: La prevalencia de la PI constituye un problema importante y persistente en las personas mayores y PCC, especialmente en las de más edad. Es pues necesaria su monitorización continuada (global y por tipos de prescripción), así como intervenciones para optimizar la prescripción, mejorando la calidad y eficiencia de la asistencia a las personas mayores y PCC. (AU)

Cost of Type 2 Diabetes Patients with Chronic Kidney Disease Based on Real-World Data: An Observational Population-Based Study in Spain.

This study analyzed the prevalence, costs and economic impact of chronic kidney disease CKD in patients with T2D in a Spanish Health District using real-world data. Observational cross-sectional study in adult patients with T2D was through data extracted from the information systems of the Valencia Clínico-La Malvarrosa Health District in the year 2015. Patients were stratified with the KDIGO classification for CKD. Additionally, patients were assigned to Clinical Risk Groups (CRGs) according to multimorbidity. Direct costs of primary and specialized care, and medication were estimated. The prevalence of T2D in the database population (n = 28,345) was 10.8% (mean age (SD) = 67.8 years (13.9); 51.5% male). Up to 14.935 patients (52.6%) had data on kidney function. According to the KDIGO classification, 66.2% of the patients were at low risk of CKD, 20.6% at moderately increased risk, 7.9% at high risk, and 5.2% at very high risk. The average healthcare costs associated with these four risk groups were EUR 3437, EUR 4936, EUR 5899 and EUR 7389, respectively. The large number of T2D patients with CKD in the early stages of the disease generated a significant increase in direct healthcare costs. The economic impact could be mitigated by early and comprehensive therapeutic approaches.

Measurement of health-related quality by multimorbidity groups in primary health care.

BACKGROUND: Increased life expectancy in Western societies does not necessarily mean better quality of life. To improve resources management, management systems have been set up in health systems to stratify patients according to morbidity, such as Clinical Risk Groups (CRG). The main objective of this study was to evaluate the effect of multimorbidity on health-related quality of life (HRQL) in primary care. METHODS: An observational cross-sectional study, based on a representative random sample (n = 306) of adults from a health district (N = 32,667) in east Spain (Valencian Community), was conducted in 2013. Multimorbidity was measured by stratifying the population with the CRG system into nine mean health statuses (MHS). HRQL was assessed by EQ-5D dimensions and the EQ Visual Analogue Scale (EQ VAS). The effect of the CRG system, age and gender on the utility value and VAS was analysed by multiple linear regression. A predictive analysis was run by binary logistic regression with all the sample groups classified according to the CRG system into the five HRQL dimensions by taking the "healthy" group as a reference. Multivariate logistic regression studied the joint influence of the nine CRG system MHS, age and gender on the five EQ-5D dimensions. RESULTS: Of the 306 subjects, 165 were female (mean age of 53). The most affected dimension was pain/discomfort (53%), followed by anxiety/depression (42%). The EQ-5D utility value and EQ VAS progressively lowered for the MHS with higher morbidity, except for MHS 6, more affected in the five dimensions, save self-care, which exceeded MHS 7 patients who were older, and MHS 8 and 9 patients, whose condition was more serious. The CRG system alone was the variable that best explained health problems in HRQL with 17%, which rose to 21% when associated with female gender. Age explained only 4%. CONCLUSIONS: This work demonstrates that the multimorbidity groups obtained by the CRG classification system can be used as an overall indicator of HRQL. These utility values can be employed for health policy decisions based on cost-effectiveness to estimate incremental quality-adjusted life years (QALY) with routinely e-health data. Patients under 65 years with multimorbidity perceived worse HRQL than older patients or disease severity. Knowledge of multimorbidity with a stronger impact can help primary healthcare doctors to pay attention to these population groups.

Pharmaceutical cost and multimorbidity with type 2 diabetes mellitus using electronic health record data.

BACKGROUND: The objective of the study is to estimate the frequency of multimorbidity in type 2 diabetes patients classified by health statuses in a European region and to determine the impact on pharmaceutical expenditure. METHODS: Cross-sectional study of the inhabitants of a southeastern European region with a population of 5,150,054, using data extracted from Electronic Health Records for 2012. 491,854 diabetic individuals were identified and selected through clinical codes, Clinical Risk Groups and diabetes treatment and/or blood glucose reagent strips. Patients with type 1 diabetes and gestational diabetes were excluded. All measurements were obtained at individual level. The prevalence of common chronic diseases and co-occurrence of diseases was established using factorial analysis. RESULTS: The estimated prevalence of diabetes was 9.6 %, with nearly 70 % of diabetic patients suffering from more than two comorbidities. The most frequent of these was hypertension, which for the groups of patients in Clinical Risk Groups (CRG) 6 and 7 was 84.3 % and 97.1 % respectively. Regarding age, elderly patients have more probability of suffering complications than younger people. Moreover, women suffer complications more frequently than men, except for retinopathy, which is more common in males. The highest use of insulins, oral antidiabetics (OAD) and combinations was found in diabetic patients who also suffered cardiovascular disease and neoplasms. The average cost for insulin was 153€ and that of OADs 306€. Regarding total pharmaceutical cost, the greatest consumers were patients with comorbidities of respiratory illness and neoplasms, with respective average costs of 2,034.2€ and 1,886.9€. CONCLUSIONS: Diabetes is characterized by the co-occurrence of other diseases, which has implications for disease management and leads to a considerable increase in consumption of medicines for this pathology and, as such, pharmaceutical expenditure.

Gasto farmacéutico en diabetes mellitus en una región de España según el Clinical Risk Group, 2012 / Pharmaceutical Expenditure for Diabetes Mellitus in a Region of Spain as Clinical Risk Group, 2012 / Despesa com medicamentos em pacientes com diabetes mellitus em uma região da Espanha como o Grupo de Risco Clínico de 2012

Se pretende estimar la multimorbilidad asociada con diabetes mellitus tipo 2 y su relación con el gasto farmacéutico, para lo cual se realizó un estudio de corte transversal durante el año 2012. Se identificó a 350 015 individuos diabéticos, a través de códigos clínicos, usando la Clasificación Internacional de Enfermedades y el software 3M Clinical Risk Groups. Todos los pacientes fueron clasificados en cuatro grupos de morbilidad. El primer grupo corresponde al estadio inicial, el segundo grupo incluye el núcleo de multimorbilidad de pacientes en fases intermedia y avanzada, el tercer grupo incluye pacientes con diabetes y enfermedades malignas, y el último grupo es de pacientes en estado catastrófico, principalmente enfermos renales crónicos. La prevalencia bruta de diabetes fue de 6,7%. El gasto promedio total fue de ¬ 1257,1. La diabetes se caracteriza por una fuerte presencia de otras condiciones crónicas y tiene un gran impacto en el gasto farmacéutico.

Estimations of multimorbidity associated with Type 2 Diabetes Mellitus and its relationship to pharmaceutical expenditure. Cross-sectional study during 2012. 350,015 diabetic individuals, identified through clinical codes using the International Statistical Classification of Diseases and Related Health Problem and the 3M Clinical Risk Groups software. The raw prevalence of diabetes was 6.7%. All patients were stratified into four morbidity groups. The first group corresponds to the initial state; the second group includes the core multimorbidity patients in the intermediate and advanced stages; the third group includes patients with diabetes and malignancies; the last group patients with catastrophic statuses, manly chronic renal patients. The raw prevalence of diabetes was 6.7%. The average total cost was ¬ 1257.1. Diabetes is characterized by a strong presence of other chronic conditions have a great impact on pharmaceutical spending.

As estimativas de vários morbidade associada com diabetes mellitus tipo 2 e sua relação com a despesa farmacêutica, para o qual um estudo transversal foi realizado em 2012. Ele foi identificado em 350 015 indivíduos diabéticos, foram identificados através códigos clínicos, utilizando a Classificação Internacional de Doenças e Risco clínica software Grupos 3M. Todos os pacientes foram classificados em quatro grupos de doença 4. O primeiro grupo corresponde à fase inicial (CRG 1-4); O segundo grupo inclui pacientes multimorbid principais fases intermediárias e avançadas, o terceiro grupo inclui pacientes com diabetes e doenças malignas, eo último grupo de pacientes em estado catastrófico, pacientes renais crónicos, principalmente. A prevalência global de diabetes foi de 6,7%. A despesa média total foi de ¬ 1257,1. Diabetes que se caracteriza por uma forte presença de outras condições crónicas e tieniendo um grande impacto sobre os gastos farmacêutica.

Methods to control the pharmaceutical cost impact of chronic conditions in the elderly.

Multimorbidity is the main cause of polypharmacy in elderly people, with the consequent increment in cost and use of inappropriate medication. To control cost, specific strategies have been implemented in healthcare services to reduce potentially inappropriate prescription. Many interventions are applied online during the prescription process using computerized decision support systems, for example, therapeutic algorithms and alerts. Other interventions can be categorized as offline due to their application before or after the prescription process, the main strategies being financial incentives, medication reviews and organizational change. All these strategies are complementary and multifaceted. There is evidence that some of these interventions are effective, but further research should be directed in this field, including investigation of patient cost and outcomes.

Pharmaceutical cost management in an ambulatory setting using a risk adjustment tool.

BACKGROUND: Pharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending. METHODS: Descriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts. RESULTS: The risk adjustment tool proved to have an acceptable level of prediction (R2 ≥ 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established. CONCLUSION: The model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.

Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups.

BACKGROUND: Risk adjustment instruments applied to existing electronic health records and administrative datasets may contribute to monitoring the correct prescribing of medicines. OBJECTIVE: We aim to test the suitability of the model based on the CRG system and obtain specific adjusted weights for determined health states through a predictive model of pharmaceutical expenditure in primary health care. METHODS: A database of 261,054 population in one health district of an Eastern region of Spain was used. The predictive power of two models was compared. The first model (ATC-model) used nine dummy variables: sex and 8 groups from 1 to 8 or more chronic conditions while in the second model (CRG-model) we include sex and 8 dummy variables for health core statuses 2-9. RESULTS: The two models achieved similar levels of explanation. However, the CRG system offers higher clinical significance and higher operational utility in a real context, as it offers richer and more updated information on patients. CONCLUSIONS: The potential of the CRG model developed compared to ATC codes lies in its capacity to stratify the population according to specific chronic conditions of the patients, allowing us to know the degree of severity of a patient or group of patients, predict their pharmaceutical cost and establish specific programmes for their treatment.

Evaluación de un modelo de predicción del gasto farmacéutico en atención primaria de salud basado en variables demográficas / Evaluation of a predictive model of pharmaceutical expenditure in primary health care based on demographic variables / Avaliação de modelo de predição de despesa farmacêutica em atenção primária à saúde baseado em variáveis demográficas

Problema: en el actual contexto de restricciones presupuestarias en el sector salud, se precisa de sistemas de gestión que permitan asignar el gasto de manera más eficiente. En el caso del gasto farmacéutico, los modelos de ajuste de riesgos en salud son herramientas que ayudan a mejorar la eficiencia. Objetivos: evaluar la capacidad predictiva de un modelo de ajuste de gasto farmacéutico, Indicador de Importe Estandarizado (he), según variables sociodemográficas: condición de farmacia, cobertura internacional, edad y sexo. Método: se incluyó la población empadronada en la Comunidad Valenciana (España) entre el 01/09/2009 y el 31/08/2010. Se estandarizó la población y se realizó un análisis de regresión lineal para explicar la variabilidad del gasto farmacéutico ambulatorio. Resultados: el sistema de ajuste evaluado supone un avance en relación con modelos anteriores, alcanzando un mayor poder predictivo (R² = 34%). Conclusiones: el he es válido para predecir el gasto farmacéutico y asignar presupuestos prospectivos a departamentos y centros de salud.

Problem: In the current context of budget constraints in the health sector management systems that allow allocating spending more efficiently are required. In the case of pharmaceutical expenditure, risk adjustment models are tools that help to improve the efficiency. Objectives: To evaluate the predictive power of a pharmaceutical expenditure adjustment model, Standardized Amount Indicator, using sociodemographic variables: Copayment, international coverage, age and sex. Methods: We included the population registered in Valencia (Spain) between 01/09/2009 and 31/08/2010. Population was standardized and linear regression analysis was performed in order to explain the variability of outpatient pharmaceutical expenditure. Results: The adjustment model evaluated improve the predictive power, reaching a R² of 34%. Conclusions: This models valid to predict pharmaceutical costs and allocate prospective budgets to health districts and centers.

Questão: No atual contexto de restrições orçamentais no sector da saúde são precisos sistemas de gestão que permitam alocar os dispêndios de forma mais eficiente. No caso da despesa farmacêutica os modelos de ajuste de risco em saúde são ferramentas que ajudam no melhoramento da eficiência. Objetivos: avaliar a capacidade preditiva de um modelo de ajuste da despesa farmacêutica, Indicador de Importe Padronizado (hp), de acordo com variáveis sociodemográficas: condição de farmácia, cobertura internacional, idade e gênero. Métodos: Foi incluída a população registrada em Valencia (Espanha) entre 01/09/2009 e 31/08/2010. A população foi padronizada e realizou-se análise de regressão linear para explicar a variabilidade dos dispêndios farmacêuticos ambulatórios. Resultados: O sistema de ajustamento avaliado supõe uma melhoria em relação aos modelos anteriores, alcançando maior poder preditivo (R2=34%). Conclusões: O iip é válido para prever os custos farmacêuticos e alocar orçamentos prospectivos aos departamentos e centros de saúde.

[A standardized amount indicator by equivalent patient to control outpatient pharmaceutical expenditure, Spain]. / Desarrollo del indicador Población Estandarizada Equivalente para el control del gasto farmacéutico ambulatorio.

BACKGROUND: The outpatient pharmaceutical expenditure in developed countries represents a huge percentage of the total health budget, because of that, it is necessary to use tools aimed to control and guarantee an efficient use of these resources. Improving the current construction of the indicator of pharmaceutical expenditure in order to have a more adjusted tool of pharmaceutical expenditure control. METHODS: We introduce the concept of "equivalent patient" in the standardization of outpatient pharmaceutical expenditure, considering in its design several socio demographic variables in order to supersede the previous model which just considered the "Co-payment status" for adjusting the outpatient pharmaceutical expenditure. We considered variables as age, sex, co-payment status and nationality to elaborate the concept of equivalent patient. RESULTS: By applying the standardization method we obtained 160 groups of consumption with weights from 0,10 to 4,39 equivalent patients. CONCLUSIONS: We obtained a tool capable of improving the construction of Pharmaceutical Expenditure Indicators, which are essential for the design of measures aimed to stimulate the rational use of drugs. In a micro level of analysis, the new indicator is useful to establish economic incentives aimed to encourage good performance from physicians in the prescription field.

Desarrollo del indicador población estandarizada equivalente para el control del gasto farmacéutico ambulatorio / A standardized amount indicator by equivalent patient to control outpatient pharmaceutical expenditure, Spain

Fundamentos: El gasto farmacéutico representa un elevado porcentaje del gasto sanitario total en la mayoría de los países desarrollados, por lo que es importante utilizar herramientas que permitan hacer un uso eficiente. El objetivo del presente trabajo es construir un indicador de gasto farmacéutico estandarizado con el fin de disponer de una herramienta objetiva de evaluación y control del gasto más precisa que el indicador utilizado hasta el momento en la Comunitat Valenciana. Métodos: Para la construcción de este indicador se introdujo el concepto de "paciente equivalente" en la estandarización de la población, lo que permitió discriminar pacientes con perfiles de consumo diferentes. Dicha estandarización tiene en cuenta una serie de variables sociodemográficas que ofrecen una estandarización de los pacientes más ajustada que la que ofrecía el modelo utilizado hasta 2011, sustituido ahora por este nuevo indicador: el anterior indicador de importe estandarizado solo consideraba como característica diferenciadora del gasto la condición de farmacia (prestación farmaceútica sin o con aportación del 40%). Las variables consideradas en el nuevo proceso de estandarización fueron, la edad, el género, la condición de prestación farmaceútica y la cobertura internacional. Resultados: Después de aplicar el método de estandarización de la población se obtuvieron 160 grupos de pacientes con consumos diferentes a los que se les adjudicó unos pesos de 0,10 a 4,39 pacientes equivalentes. Conclusiones: El indicador obtenido permite comparar poblaciones homogéneas a través del proceso de su estandarización, lo que facilita la evaluación y control del gasto farmacéutico ambulatorio considerando los patrones de consumo de cada estructura poblacional. El indicador se puede aplicar a cualquier nivel organizativo, desde departamentos de salud a facultativos, por lo que ofrece información necesaria para el establecimiento de incentivos encaminados a promover una prescripción más eficiente(AU)

Background: The outpatient pharmaceutical expenditure in developed countries represents a huge percentage of the total health budget, because of that, it is necessary to use tools aimed to control and guarantee an efficient use of these resources. Improving the current construction of the indicator of pharmaceutical expenditure in order to have a more adjusted tool of pharmaceutical expenditure control. Methods: We introduce the concept of "equivalent patient" in the standardization of outpatient pharmaceutical expenditure, considering in its design several socio demographic variables in order to supersede the previous model which just considered the "Co-payment status" for adjusting the outpatient pharmaceutical expenditure. We considered variables as age, sex, co-payment status and nationality to elaborate the concept of equivalent patient. Results: By applying the standardization method we obtained 160 groups of consumption with weights from 0,10 to 4,39 equivalent patients. Conclusions: We obtained a tool capable of improving the construction of Pharmaceutical Expenditure Indicators, which are essential for the design of measures aimed to stimulate the rational use of drugs. In a micro level of analysis, the new indicator is useful to establish economic incentives aimed to encourage good performance from physicians in the prescription fiel(AU)

[Utilization of patient isolation in non critical units from a university hospital]. / Utilización del aislamiento infeccioso en pacientes no críticos de un hospital universitario.

BACKGROUND AND OBJECTIVE: Correct utilization of source isolation (SI) in hospitals is important to take advantage of hospital resources. The objective of this work was to evaluate the utilization of SI considering the appropriateness of isolation length-stay. PATIENTS AND METHOD: During a period of 19 months a prospective observational study was carried out among non-critical inpatients who underwent SI in a university hospital. The information was obtained from Admission Unit data, daily ward rounds and review of case history records. RESULTS: A total of 239 SIs were identified, summarizing 2,589 days in isolation (median: 8 days, range: 1-56 days). These data supposed a cumulative incidence of 6.74 isolations by 1,000 admissions, and an incidence density of 1.08 isolations by 1,000 inpatient-day. 36.8% of SIs were considered incorrectly used, meaning a total of 703 inappropriate stays in isolation (27.1% of all stays carried out in SI). Surgical wound infections prompted inappropriate isolations with a greater frequency (45.2%), mainly after hip and knee prosthesis implantation interventions (42.9% and 17.9%, respectively). CONCLUSIONS: It is necessary to develop quality criteria and indicators in order to implement quality improvement actions to optimize SI length-stay management.

Utilización del aislamiento infeccioso en pacientes no críticos de un hospital universitario / Utilization of patient isolation in non critical units from a university hospital

Fundamento y objetivo: La correcta utilización del aislamiento infeccioso (AI) en los hospitales es importante para el adecuado aprovechamiento de los recursos hospitalarios, así como para el bienestar del paciente aislado. El objetivo de este trabajo es evaluar la utilización del AI medido a través de la adecuación de estancias. Pacientes y método: Durante un período de 19 meses se realizó un estudio prospectivo observacional de los AI indicados a pacientes no críticos de un hospital universitario de la Comunidad Valenciana. La información se obtuvo a partir de los datos de la unidad de admisión, la visita diaria a las salas de hospitalización y la consulta de las historias clínicas. Resultados: Se indicó un total de 239 AI que sumaron 2.589 estancias en AI (mediana de 8 días; extremos: 1-56 días). La incidencia acumulada en el período de estudio fue de 6,74 AI por cada 1.000 ingresos y la densidad de incidencia, de 1,08 AI por paciente-día. El 36,8% de los AI indicados se consideraron incorrectos, lo que se tradujo en 703 estancias en AI inadecuadas, es decir, un 27,1% del total de estancias realizadas en AI. Las infecciones de herida quirúrgica motivaron la inadecuación de los AI con mayor frecuencia (45,2%), sobre todo tras intervenciones de inserción de prótesis de cadera y rodilla (el 42,9 y el 17,9%, respectivamente). Conclusiones: Es necesario elaborar criterios e indicadores de calidad para implementar acciones de mejora continua que permitan optimizar la gestión de las estancias realizadas en AI

Background and objective: Correct utilization of source isolation (SI) in hospitals is important to take advantage of hospital resources. The objective of this work was to evaluate the utilization of SI considering the appropriateness of isolation length-stay. Patients and method: During a period of 19 months a prospective observational study was carried out among non-critical inpatients who underwent SI in a university hospital. The information was obtained from Admission Unit data, daily ward rounds and review of case history records. Results: A total of 239 SIs were identified, summarizing 2,589 days in isolation (median: 8 days, range: 1-56 days). These data supposed a cumulative incidence of 6.74 isolations by 1,000 admissions, and an incidence density of 1.08 isolations by 1,000 inpatient-day. 36.8% of SIs were considered incorrectly used, meaning a total of 703 inappropriate stays in isolation (27.1% of all stays carried out in SI). Surgical wound infections prompted inappropriate isolations with a greater frequency (45.2%), mainly after hip and knee prosthesis implantation interventions (42.9% and 17.9%, respectively). Conclusions: It is necessary to develop quality criteria and indicators in order to implement quality improvement actions to optimize SI length-stay management